Organization
CASA GRANDE FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL JACKSON PA (OWNER)
(801) 310-0819
Entity
Organization
Contact information
Practice address
580 N CAMINO MERCADO STE 24, CASA GRANDE, AZ 85122-5757
(801) 310-0819
(801) 310-0819
Mailing address
580 N CAMINO MERCADO STE 24, CASA GRANDE, AZ 85122-5757
(801) 310-0819
(801) 310-0819
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
08/05/2026
Last updated
08/05/2026
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